Author
Topic: Billing for diagnostic testing (Read 1676 times)

I am setting up billing for a new diagnostic lab. We will have patients across the U.S. so will be working with many different carriers. We are in the process of enrolling with our local Medicare carrier. When we receive a case for a patient with Medicare who is outside of the state where our lab is, will we send claims to the address on the patient's card or to our local carrier?

Thank you for the previous response. The credentialing process for clinical laboratories does not seem to be as straightforward as for individual providers. When I speak with payers, they often do not know which applications we should be completing as an independent lab. As a lab, I believe we cannot complete credentialing applications via CAQH (I saw this on another post on this site) - is this correct? Do you have any recommendations regarding how I can approach payers for credentialing requirements for a lab?

Also, is credentialing only required if we want to be in-network with the payer or is credentialing required regardless. Have you heard of payers coming to do inspections at the lab site before approving the application? I've heard Medicare will do this, but I'm unsure about other commercial payers.

Our lab is determining a risk score based on a series of tests. Is there a regulation requiring us to disclose on our requistion form that the physician is ordering a panel of tests? If you have heard of such a regulation, do you know of resources I can access to research it?

I am not sure if there is any regulation requiring you to disclose your requisition form. I'm not even sure where to point you to find out. You could try the state insurance commissioner for your state. Or maybe someone else on the forum could help us out.